You should get a notice within 1 – 2 weeks after submitting your claim.
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File a claim against the Workers' Compensation Trust Fund (WCTF)
Find out how to file a claim with the Department of Industrial Accidents (DIA) if your employer does not have workers’ compensation insurance.
Contact for File a claim against the Workers' Compensation Trust Fund (WCTF)
Public Information Office
Phone
Phones open M-F 8 am - 5 pm
Phones open M-F 8 am - 5 pm
Toll Free In Massachusetts Only
Call Public Information Office, Toll Free In Massachusetts Only at (800) 323-3249
Phones open M-F 8 am - 5 pm.
The Details of File a claim against the Workers' Compensation Trust Fund (WCTF)
What you need for File a claim against the Workers' Compensation Trust Fund (WCTF)
To file a workers’ compensation claim with the Department of Industrial Accidents (DIA) against the Workers’ Compensation Trust Fund (WCTF) you will need to know:
- Your date of injury, illness, or death if a dependent is filing for benefits
- The 1st calendar day of work you missed
- The 5th calendar day of work you missed
- The body parts and types of injuries
- What type of benefits you are looking for
- How long you may be out of work, if known
- Where you first went for treatment
- Your current treating doctor
If you file a claim seeking weekly compensation benefits, you're required to attach a copy of a doctor's report or record not more than 6 months old that describes the extent and length of time of your physical or emotional incapacity for work. This report must also relate your incapacity to your claimed industrial injury.
You are also required to attach a Certificate of No Insurance and DIA Form 170 - Affidavit of Employee in Application for Trust Fund Benefits.
How to file File a claim against the Workers' Compensation Trust Fund (WCTF)
To file a claim against the WCTF, you will need to file 3 documents and any supporting documentation as required:
To verify that your employer has no workers’ compensation insurance.
- Log in to your account, select form 110 from the online forms menu. List DIA Legal Counsel as the insurer.
- Download and fill out the Form 170 – Affidavit of Employee in Application for Trust Fund Benefits.
- Download and fill out an Insurer Request Certification Form. Mail the form to
Tom Finneran
Office of Insurance
Department of Industrial Accidents
19 Staniford St., 5th Floor
Boston, MA 02114
This form verifies that your employer has no workers' compensation insurance coverage. The Office of Insurance will send you a certified letter called a Certification of No Insurance.
Include the original certified letter when you file the Form 110 – Employee Claim.
You will need 3 copies of all the forms and documents
- 1 copy for the DIA
- 1 copy for the Workers’ Compensation Trust Fund
- 1 copy for your records, or in case you hire an attorney later
Send your signed Form 110 – Employee Claim with copies of your supporting documents, Certification of No Insurance, and Form 170 - Affidavit of Employee in Application for Trust Fund Benefits to:
Department Industrial Accidents
Dept. 110
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
Also send a copy by certified mail to:
Workers’ Compensation Trust Fund
c/o Department Industrial Accidents
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
Submit your original copy of Form 110 – Employee Claim with copies of your supporting documents, original Certification of No Insurance, and Form 170 - Affidavit of Employee in Application for Trust Fund Benefits in person at the DIA office:
Department Industrial Accidents
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
Next steps for File a claim against the Workers' Compensation Trust Fund (WCTF)
Notification and investigations
You will be contacted by a claims representative and an investigator from the DIA to discuss your claim.
You will receive a notice from the DIA regarding a conciliation for your claim. A conciliation is the first step in the dispute process.
Contact for File a claim against the Workers' Compensation Trust Fund (WCTF)
Address
Phone
Phones open M-F 8 am - 5 pm
Phones open M-F 8 am - 5 pm
Toll Free In Massachusetts Only
Call Public Information Office, Toll Free In Massachusetts Only at (800) 323-3249
Phones open M-F 8 am - 5 pm.
Fax
(617) 727-7470
Address
The Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Address
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Fax
(617) 727-6659